2485 Identifying Barriers for Same-Day Discharge of Minimally Invasive Hysterectomies

Abstract

Study Objective Minimally invasive surgery (MIS) has provided patients with decreased post-surgical pain, faster recovery, and shorter hospital stay. Currently, the trend with MIS procedures is to have same-day discharge. The purpose of this study is to determine which patient-based and post-surgical factors are barriers to same-day discharge and lead to hospital re-admission. Design Quality assurance, retrospective cohort study. Setting Single academic institution Patients or Participants Chart review for patients undergoing laparoscopic, vaginal, laparoscopic assisted vaginal or robotic hysterectomy from July 2014 to April 2017. Cohort of 541 patients from 18-84 years-old with a mean age of 48. Interventions No interventions. Descriptive study of post-operative hospital stay following surgery. Measurements and Main Results We performed an electronic medical record chart review to evaluate time in the recovery room following surgery, route of hysterectomy, reasons for prolonged hospital stay, and re-admission. Out of 541 patients, 395 (73%) were general gynecology patients and 146 (27%) were urogynecology patients. Despite the goal of same-day discharge, only 252 (47%) of patients were discharged the same day. Of those patients, 83% were vaginal hysterectomies and 84% were laparoscopic hysterectomies that were discharged in less than 6 hours. 145 (99.3%) urogynecology patients stayed admitted overnight. There was an association between length of case, urogynecology patients, and overnight stay (OR 1.23, CI 1.006 - 1.521), but no association was found between length of stay in recovery with estimated blood loss. There was no statistical significance (p>0.05) between hours of recovery room stay with emergency room visits or re-admissions. Conclusion The majority of the patients in the cohort were not discharged the same-day given that data was altered by urogynecology patients despite having MIS procedures. Barriers to same-day discharge included length of procedure, voiding dysfunction and pain. Further studies include implementing enhanced recovery after surgery and voiding trials for same-day discharge, as well as evaluating urogynecology patients separate from general gynecologic procedures.